Health Insurance, Health Care and Consumer Affairs
53 Answers 107 Helpful Votes 5 Followers
There are a number of circumstances under which you're entitled to appeal your insurer's decisions. You can appeal if your insurer:
Denied payment for your care
Ruled that your care was not medically necessary
Said that you're not eligible for the benefit in question
Claimed that your treatment is experimental
Claimed that you have a pre-existing condition (when your plan does not cover them)
By law, your insurer must review your appeal and make a determination within certain timelines:
72 hours for denials of urgent care.
30 days for denials of nonurgent care you have not yet received.
60 days for denials of service you have already received.
If your insurance company has been paying for your care and made a recent decision to stop, it's always worth asking that it continue paying for your treatment until a determination on your appeal has been made.
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